Provider Demographics
NPI:1841228129
Name:WAGNER, MARGARET A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:A
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S WOODRUFF AVE
Mailing Address - Street 2:SUITE #15
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6374
Mailing Address - Country:US
Mailing Address - Phone:208-522-7310
Mailing Address - Fax:208-524-0559
Practice Address - Street 1:2001 S WOODRUFF AVE
Practice Address - Street 2:SUITE #15
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6374
Practice Address - Country:US
Practice Address - Phone:208-522-7310
Practice Address - Fax:208-524-0559
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDMD2942OtherIDAHO STATE NARC. #
ID000010003953OtherREGENCE BLUE SHIELD
ID4284-6OtherBLUE CROSS
ID4284-6OtherBLUE CROSS
IDMD2942OtherIDAHO STATE NARC. #
ID1114190Medicare ID - Type UnspecifiedPROVIDER #